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Eur J Cardiothorac Surg 2006;29:908-913
© 2006 Elsevier Science NL

Does perioperative high-dose prednisolone have clinical benefits for generalized myasthenia gravis?

^a Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
^b Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
^c Graduate School of BioMedical Statistics, Tokyo University of Science, Tokyo, Japan

Received 10 January 2006; received in revised form 7 March 2006; accepted 13 March 2006.

^_* Corresponding author. Tel.: +81 43 222 7171x5464; fax: +81 43 226 2172. (Email: sekine{at}faculty.chiba-u.jp).

Objective: The purpose of this study was to clarify the clinical benefits of perioperative administration of high-dose prednisolone (PSL) combined with extended thymectomy on the long-term outcomes of 116 consecutive patients with generalized myasthenia gravis (MG). Methods: A retrospective review was conducted on 116 patients diagnosed with generalized MG who received alternate-day oral administration of high-dose PSL (100 mg/alternate days) and had undergone transsternal extended thymectomy. Incidences of postoperative myasthenic crisis, adverse effects of steroid, long-term outcomes, such as complete stable remission (CSR), pharmacologic remission (PR) or improvement (Imp), and disease recurrence after CSR were evaluated. Results: Six patients (5.2%) experienced post-thymectomy myasthenic crisis. Crude cumulative CSR and PR + CSR rates were 44.8 and 62.7%, respectively. Life table analysis showed that 41.8, 52.8 and 63.4% of the patients were in CSR at 3, 5 and 10 years, respectively. Multivariate analysis revealed that age and pretreatment classification according to the Myasthenia Gravis Foundation of America (MGFA) criteria tended to be independent predictors of CSR. There were 6.9% with compressive vertebral fracture, 13.8% with cataract, and 5.2% with steroid-induced diabetes. Life table analysis revealed that recurrence rates after CSR were 36.8 and 46.0% at 3 and 5 years, respectively. Patients with thymoma had a significantly higher rate of recurrence than those without thymoma (p = 0.001). Conclusions: Alternate-day administration of high-dose prednisolone reduced the risk of post-thymectomy myasthenic crisis. Presence of thymoma was a risk factor for MG recurrence after CSR.

Key Words: Myasthenia gravis • High-dose prednisolone • Extended thymectomy • Long-term outcome

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